Paternalism in Public Health Care

Nys, Thomas

doi:10.1093/phe/phn002

Cited by 44 publications

(26 citation statements)

References 7 publications

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“…Starting in the 1970s, the policy of compulsory health measures was criticized as "paternalism", defined as "an attitude or policy, taken by a person, an organization or a state, that limits some person's or group's liberty or autonomy for what is presumed to be that person's or group's own good" (Nys, 2008) (Buchanan, 2008).…”

Section: Question Of Autonomy Within An Organised Screeningmentioning

confidence: 99%

Low participation in organized colorectal cancer screening in France: underlying ethical issues

Moutel

Duchange

Lièvre

et al. 2019

European Journal of Cancer Prevention

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International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50-74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.

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Section: Question Of Autonomy Within An Organised Screeningmentioning

confidence: 99%

Low participation in organized colorectal cancer screening in France: underlying ethical issues

Moutel

Duchange

Lièvre

et al. 2019

European Journal of Cancer Prevention

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“…It is worth noting that paternalism is not unique to the Arabic health care system and has been well documented worldwide (Cody ). However, there has been a slow shift in developed countries to a more collaborative approach over the past several decades (Nys ).…”

Section: Recovery‐oriented Mental Health Servicesmentioning

confidence: 99%

Exploring personal recovery in mental illness through an Arabic sociocultural lens

Hickey

Pryjmachuk

Waterman

2016

Psychiatric Ment Health Nurs

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“…Oughtonomy is relevant to the question how to prevent people from making unhealthy lifestyle choices: how to question the unhealthy choices people make, without being paternalistic? This question is prominently present in today' health care, from the debates on smoking cessation and alcoholism to diabetes and many other lifestyle diseases [16,[20][21][22] .…”

Section: Oughtonomymentioning

confidence: 99%

Nudging and obesity: How to get rid of paternalism?

Devisch

2012

JNEP

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This paper reflects upon the conditions how 'nudging' can change individual health choices without being paternalistic and therefore can be defined as an instrument of social justice? So many problems we are facing in today's nursing are situated at the intersection of autonomy and heteronomy, i.e. why well informed and autonomous people make unhealthy lifestyle choices. If people do not choose what they want, this is not simply caused by their lack of character or capability, but also by the fact that absolute autonomy is impossible; also autonomous individuals are 'contaminated' by heteronymous aspects, by influences from 'outside'. In an earlier article I made an analysis of my neologism 'oughtonomy' to support the thesis that when it comes down to human existence, autonomy and heteronomy are intertwined, more than they are merely opposites.Although nudging might be of help in many nursing settings, we should evaluate it with the same criticism as we judge upon paternalism. Despite the potential of nudging for nursing, there is a risk to put the nurse again in the position of the paternalistic outsider who knows how people should behave. But maybe the awareness of the oughtonomous decisions we all make in our lives, can help us to understand why people act mindless in some situations or why we choose what we choose. Knowing this is one thing, giving people the authority of an expert to know what is better off for others, another. Despite the potential of the last, the former concept does not legitimate paternalistic interferences in patient's lifestyle.

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Paternalism in Public Health Care

Cited by 44 publications

References 7 publications

Low participation in organized colorectal cancer screening in France: underlying ethical issues

Low participation in organized colorectal cancer screening in France: underlying ethical issues

Exploring personal recovery in mental illness through an Arabic sociocultural lens

Nudging and obesity: How to get rid of paternalism?

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